The White House announced Monday that nine more pharmaceutical manufacturers — including Teva Pharmaceuticals, Sun Pharma, Alcon, and Astellas Pharma — have signed onto President Trump's voluntary Most-Favored-Nation drug pricing framework, pushing the total number of participating companies to 26 and covering an estimated 89% of the U.S. branded drug market.
The expansion builds on a program Trump revived through an executive order signed in May 2025, which directed federal health agencies to set drug price targets for Medicare and Medicaid based on prices paid in other wealthy nations. As reported by WBFF, the administration had already lined up deals with companies including Novo Nordisk, Eli Lilly and Pfizer before Monday's additions, and per Bloomberg drugmakers are expected to align prices paid by U.S. states with the costs those same companies charge foreign governments.
The reference basket driving those target prices covers eight high-income countries — Canada, Denmark, France, Germany, Italy, Japan, Switzerland and the United Kingdom — according to Fierce Pharma. The gap those benchmarks are meant to close is substantial: a RAND Corporation study using 2022 data found U.S. manufacturer gross prices for brand-name originator drugs averaged 422% of prices across 33 comparison nations, even though American generic drug prices ran 33% below foreign averages.
How the Deals Actually Work
Under the agreements, companies are expected to offer discounts on drugs sold to state Medicaid programs and to list medications on TrumpRx, a presidential portal where Americans can buy prescriptions at reduced cash prices, per WBFF's reporting. Some companies in the MFN deals are also spending billions of dollars to bring manufacturing back to the United States, though the exact impact on patients' out-of-pocket costs remains unclear.
There's a wrinkle that complicates the White House's savings pitch: Medicaid already receives generous discounts from drugmakers under existing federal law, independent of any new voluntary deal. Federal statute requires brand-name manufacturers to provide state Medicaid programs a basic rebate of at least 23.1% of the Average Manufacturer Price, or the difference between that price and the drug's best price, whichever is greater, according to KFF. That statutory floor, in place since the Omnibus Budget Reconciliation Act of 1990, leaves open exactly how much additional savings the new Medicaid rebate terms actually deliver.
A Pattern of Price Hikes Despite the Deals
Consumer advocates have raised a more pointed concern: the voluntary structure of MFN agreements does not legally cap the list prices companies charge on existing drugs. A Public Citizen analysis published earlier this month found that all 16 pharmaceutical companies that signed initial MFN deals with the administration went on to raise list prices on 272 drugs in early 2026. Hoodline previously reported that a Senate report led by Sen. Bernie Sanders reached a similar conclusion, showing drugmakers hiked list prices on hundreds of medicines after entering the pricing agreements.
Biotech companies, meanwhile, would be exempt from Medicare pilot programs mandating similar discounts, per Bloomberg. The administration is not the first to try an MFN-style approach: during Trump's first term, CMS issued an interim final rule for Medicare Part B in November 2020, only to see federal district courts block it with nationwide preliminary injunctions after pharmaceutical trade groups sued over Administrative Procedure Act violations. CMS formally rescinded that rule in December 2021.
Voluntary Deals Versus Mandatory Negotiation
The voluntary MFN push stands in contrast to a legally binding mechanism already in effect: the Inflation Reduction Act of 2022 mandated Medicare drug price negotiations, and the first set of lower negotiated prices for 10 high-expenditure Part D medications — including blockbusters like Eliquis and Jardiance — took effect on January 1 of this year, according to KFF. Unlike the MFN agreements, that statutory negotiation process carries the force of tax penalties for noncompliance.
Some drugmakers appear to be recalibrating their global pricing strategies in anticipation of continued MFN pressure. AstraZeneca executives disclosed on a Q2 2026 investor call that the company restructured its global launch pricing for new medicines specifically to adapt to the reference-pricing push, Hoodline reported at the time. The administration has also paired the pricing push with trade pressure: Trump announced a phased tariff schedule on imported generic drugs in July, keeping duties at zero through August 1 before ramping to 100% in 2028 and 200% in 2029, a policy Hoodline covered as part of its push to get drugmakers to build manufacturing plants domestically.
Trump is expected to sign a deal with nearly a dozen drugmakers to voluntarily sell medications for less, per an MS NOW report cited by WBFF, as part of a broader White House effort to spotlight healthcare affordability ahead of the midterms. The administration has previously announced Most-Favored-Nation drug pricing deals with 17 pharmaceutical companies, and Monday's addition of nine more manufacturers marks the latest expansion of a policy the White House continues to promote as a centerpiece of its economic agenda.
